Mise en place et modalités d’organisation d’un Plan blanc à l’échelle d’un établissement de santé

The disaster plan is a regulatory requirement. Its aim is to adapt the daily organization of a care centre in case of an extraordinary situation while preserving the quality of care for inpatients. It allows to cope either with numerous patients or with any risk endangering the hospital. An institutional procedure should be developed with the creation of a technical pilot committee whose purpose is to prepare an operational document. These guidelines should be often reevaluated according to practices or feedbacks. The procedure describes the disaster plan organization, including the crisis management unit, staff recall, admission of patients in emergency medical unit (triage) and in wards, cancellation of hospitalizations, reception of close relatives, internal and external communication. An annual training with pre-written crisis scenarios must be provided to each professional to master his own unit strategy.     

Le meilleur de l’échoendoscopie en 2009: « TOP 5 » de la littérature scientifique

A research on Pubmed, covering a 12-month time period, from January 12, 2008 to November 30, 2009, using the keywords EUS, echo-endoscopy, and endoscopic ultrasound retrieved 684 articles. Restricting to the English and French literatures, selecting only clinical trials performed in humans allowed to lower the number to 108 articles. Selecting a Top 5 is though a cruel task because of several leftover good quality articles. However, five subjects are covered based on the quality and originality of the work and the notoriety of the journal. They are described and commented in this article.     

Sevrage de la ventilation mécanique chez l’enfant (en dehors du nouveau-né)

The process of weaning from mechanical ventilation (SVM) is the same in children as in adults. In the literature, weaning and/or extubation failure rate ranges from 4.9 to 34%. So far, no weaning predictors have been demonstrated to be sufficiently accurate. Nevertheless, endurance has never been investigated in children more at risk of respiratory muscle fatigue. Criteria to determine whether patients can be considered for discontinuation have neither been validated nor adapted to the children population. The spontaneous breathing test (SBT) is the recommended screening test for weaning: nevertheless, it has never been validated and has rarely been studied in children. In infants as in children, it can be achieved with pressure support ventilation or spontaneous breathing (T piece or canopy). A standardised weaning protocol was used only twice in the pediatric literature. Impact of such protocols in shortening the duration of VM and SVM is not yet demonstrated; it must be distinguished from the impact of sedation protocols. Weaning criteria, and criteria of SBT and/or protocol tolerance are guides, but decisions to use these criterias must be individualized. In children as in adults, weaning from mechanical ventilation may depend on patient’s disease. The implementation of noninvasive ventilation in weaning protocols could modify the definitions of weaning failure and weaning success.